BioNTech veya Sinovac ile aşılanmış bireylerde COVİD-19 sonrası akciğer komplikasyonlarının karşılaştırılması

Öz

Amaç: Uzun Koronavirüs Hastalığı 2019 (KOVİD-19) sendromu veya akut sonrası sekeller üzerinde aşının etkisini araştırmak için çeşitli araştırmalar yapılmış olsa da, aşıların akciğer sekeli ile ilişkili hastalıklar üzerindeki uzun vadeli etkilerine dair yayımlanmış kanıtlar sınırlıdır. Küresel KOVİD-19 aşı dağıtımının sınırlı olması göz önüne alındığında, aşının akciğer komplikasyonlarını azaltmadaki etkisini belirlemek hayati önem taşımaktadır. Türkiye’de, KOVİD-19 aşıları BNT162b2 (Pfizer-BioNTech, mRNA aşısı) ve CoronaVac (Sinovac, inaktif aşı) dahil olmak üzere iki platformdan sunulmaktadır. Bu çalışma, BioNTech ve Sinovac aşılarının KOVİD-19 sonrası akciğer komplikasyonlarını azaltmadaki etkinliğini değerlendirmeyi amaçladı. Gereç ve Yöntemler: İlk KOVİD-19 enfeksiyonlarından önce aldıkları BioNTech veya Sinovac aşılarının miktarına göre kategorize edilen toplam 94 KOVİD-19 pnömonisi hastası çalışmaya dahil edildi. Dahil etme kriterleri, polimeraz zincir reaksiyonu (PCR) testi ile doğrulanmış KOVİD-19 pnömonisi tanısı, belirli takip ve başlangıç bilgisayarlı tomografi taramalarının mevcut olması ve en az bir doz aşı uygulanmış olmasını içeriyordu. Bulgular: KOVİD-19 sonrası akciğer komplikasyonları yaşayan ve Sinovac ile tam aşılanan hastalardaki komplikasyon sayısı, BioNTech ile aşılananlara göre anlamlı derecede daha yüksekti. Komplikasyon yaşayan Sinovac grubundaki bireylerin C-reaktif protein ve D-Dimer ölçümleri başlangıç tarihinde önemli ölçüde yüksekti. Sonuç: İnaktif virüs aşılarında KOVİD sonrası akciğer sekel miktarı ve bu sonucu gösteren laboratuvar parametreleri mRNA aşısına göre yüksek bulunmuştur. Bu durum ağır vakalarda inaktive aşıların korumasının yetersiz olabileceğini düşündürmektedir.

Anahtar Kelimeler

• akciğer sekeli
• aşılama
• koronavirüs hastalığı
• göğüs BT
• inaktive aşılar
• mRNA aşıları

Does the incidence of post-COVID pulmonary complications in vaccinated individuals correlate with the types of vaccines they received?

Öz

Aim: Although several research have been undertaken to investigate the impact of the vaccination on long Coronavirus Disease 2019 (COVID-19) syndrome or post-acute sequelae, there is a lack of published evidence on the long-term effects of vaccines on lung-sequelae-related disease. Considering the limited global COVID-19 vaccine distribution, it is essential to establish the impact of vaccination in reducing pulmonary complications. Turkey has been offering COVID-19 vaccines from two platforms, including BNT162b2 (Pfizer-BioNTech, mRNA vaccine) and CoronaVac (Sinovac, inactivated vaccine). This study aimed to evaluate the efficacy of BioNTech and Sinovac vaccines in reducing post-COVID-19 pulmonary complications in individuals. Material and Methods: A total of 94 patients COVID-19 pneumonia patients who were categorized based on the quantity of BioNTech or Sinovac vaccines they received before their first COVID-19 infection were included. The inclusion criteria consisted of a confirmed diagnosis of COVID-19 pneumonia through polymerase chain reaction testing, availability of the mentioned before and follow-up computed tomography scans, and administration of at least one dose of vaccine. Results: The number of complications in patients fully vaccinated with Sinovac and who experienced post-COVID lung complications was significantly greater than in those vaccinated with BioNTech. The C-reactive protein and D-Dimer measurements of individuals who experienced complications in the Sinovac vaccinated group were significantly elevated on the index date. Conclusion: The quantity of lung sequelae after COVID and laboratory parameters indicating this result were found to be higher in inactivated virus vaccines than in mRNA vaccines. This suggests that the protection of inactivated vaccines may be insufficient in severe cases.

Anahtar Kelimeler

• lung sequelae
• vaccination
• coronavirus disease
• chest CT
• inactivated vaccines
• mRNA vaccines

Kaynakça

1. Bull-Otterson L, Baca S, Saydah S, et al. Post–COVID conditions among adult COVID-19 survivors aged 18–64 and ≥65 years—United States, March 2020–November 2021. MMWR Morb Mortal Wkly Rep. 2022; 71(21): 713-717.
2. Lam ICH, Zhang R, Man KKC, et al. Persistence in risk and effect of COVID-19 vaccination on long-term health consequences after SARS-CoV-2 infection. Nat Commun. 2024; 15: 1716.
3. Cohen K, Ren S, Heath K, et al. Risk of persistent and new clinical sequelae among adults aged 65 years and older during the post-acute phase of SARS-CoV-2 infection: Retrospective cohort study. BMJ. 2022; 376: e068414
4. WHO Coronavirus (COVID-19) Dashboard. Available online: https://covid19.who.int (accessed on 18 October 2023).
5. Al-Aly Z, Xie Y, Bowe B. High-dimensional characterization of post-acute sequelae of COVID-19. Nature. 2021; 594(7862): 259-264.
6. Thaweethai T, Jolley SE, Karlson EW, et al. Development of a definition of postacute sequelae of SARS-CoV-2 infection. JAMA. 2023; 329(22): 1934-1946.
7. Daugherty SE, Guo Y, Heath K, et al. Risk of clinical sequelae after the acute phase of SARS-CoV-2 infection: Retrospective cohort study. BMJ. 2021; 373: n1098
8. Wan EYF, Mathur S, Zhang R, et al. Association of COVID-19 with short- and long-term risk of cardiovascular disease and mortality: A prospective cohort in UK Biobank. Cardiovasc Res. 2023; 119(8): 718-1727.

9. Bowe B, Xie Y, Al-Aly Z. Acute and postacute sequelae associated with SARS-CoV-2 reinfection. Nat Med. 2022; 28: 2398-2405.
10. Watanabe A, So M, Iwagami M, et al. One-year follow-up CT findings in COVID-19 patients: A systematic review and meta-analysis. Respirology. 2022; 27: 605-616.
11. Wu X, Dong D, Ma D. Thin-section computed tomography manifestations during convalescence and long-term follow-up of patients with severe acute respiratory syndrome (SARS). Med Sci Monit. 2016; 22: 2793-2799.
12. Bahadir S, Kabacaoglu E, Memis KB, et al. The effects of vaccines on the sequelae rates of recurrent infections and the severity of pulmonary COVID-19 infection by imaging. Vaccines. 2023; 11: 1321.
13. Sonmezer MC, Dizman GT, Erul E, et al. Relative vaccine effectiveness of the third dose of CoronaVac or BNT162b2 following a two-dose CoronaVac regimen: A prospective observational cohort study from an adult vaccine center in Turkey. Vaccines. 2022; 10: 1140.
14. Yan VKC, Wan EYF, Ye X, et al. Waning effectiveness against COVID-19-related hospitalization, severe complications, and mortality with two to three doses of CoronaVac and BNT162b2: A case-control study. Emerg Microbes Infect. 2023; 12(1): 2209201.
15. Aydin S, Unver E, Karavas E, et al. Computed tomography at every step: Long coronavirus disease. Respir Investig. 2021; 59(5): 622-627.
16. Gao P, Liu J, Liu M. Effect of COVID-19 vaccines on reducing the risk of long COVID in the real world: A systematic review and meta-analysis. Int J Environ Res Public Health. 2022; 19: 12422.
17. Miller TE, Garcia Beltran WF, Bard AZ, et al. Clinical sensitivity and interpretation of PCR and serological COVID-19 diagnostics for patients presenting to the hospital. FASEB J. 2020; 34(10): 13877-13884.
18. Hansell DM, Bankier AA, MacMahon H, et al. Fleischner Society: Glossary of terms for thoracic imaging. Radiology. 2008; 246: 697-722.
19. Prasad NK, Lake R, Englum BR, et al. COVID-19 vaccination associated with reduced postoperative SARS-CoV-2 infection and morbidity. Ann Surg. 2022; 275(1): 31-36.
20. Polack FP, Thomas SJ, Kitchin N, et al. Safety and efficacy of the BNT162b2 mRNA COVID-19 vaccine. N Engl J Med. 2020; 383(27): 2603-2615.
21. Ayoubkhani D, Bermingham C, Pouwels KB, et al. Trajectory of long COVID symptoms after COVID-19 vaccination: Community based cohort study. BMJ. 2022; 377: e069676.
22. Jara A, Undurraga EA, González C, et al. Effectiveness of an inactivated SARS-CoV-2 vaccine in Chile. N Engl J Med. 2021; 385(10): 875-884.
23. Geisen UM, Berner DK, Tran F, et al. Immunogenicity and safety of anti-SARS-CoV-2 mRNA vaccines in patients with chronic inflammatory conditions and immunosuppressive therapy in a monocentric cohort. Ann Rheum Dis. 2021; 80(10): 1306-1311.
24. Haberman RH, Herati R, Simon D, et al. Methotrexate hampers immunogenicity to BNT162b2 mRNA COVID-19 vaccine in immune-mediated inflammatory disease. Ann Rheum Dis. 2021; 80(10): 1339-1344.
25. Woodruff MC, Ramonell RP, Nguyen DC, et al. Extrafollicular B cell responses correlate with neutralizing antibodies and morbidity in COVID-19. Nat Immunol. 2020; 21(12): 1506-1516.
26. Kaneko N, Kuo HH, Boucau J, et al. Loss of Bcl-6-Expressing T Follicular Helper Cells and Germinal Centers in COVID-19. Cell. 2020; 183(1): 143-157.e13.
27. Furer V, Eviatar T, Zisman D, et al. Immunogenicity and safety of the BNT162b2 mRNA COVID-19 vaccine in adult patients with autoimmune inflammatory rheumatic diseases and in the general population: A multicentre study. Ann Rheum Dis. 2021; 80(10): 1330-1338.
28. Seyahi E, Bakhdiyarli G, Oztas M, et al. Antibody response to inactivated COVID-19 vaccine (CoronaVac) in immune-mediated diseases: A controlled study among hospital workers and elderly. Rheumatol Int. 2021; 41(8): 1429-1440.
29. Jena A, Mishra S, Deepak P, et al. Response to SARS-CoV-2 vaccination in immune-mediated inflammatory diseases: Systematic review and meta-analysis. Autoimmun Rev. 2022; 21(1): 102927.
30. Tarraso J, Safont B, Carbonell-Asins JA, et al. Lung function and radiological findings 1 year after COVID-19: A prospective follow-up. Respir Res. 2022; 23(1): 242.
31. Abdel-Hamid HM, Rizk HI, Magdy S. Occurrence of pulmonary residuals as one of the sequelae of COVID-19 and its predictors among moderate and severe cases. Indian J Tuberc. 2021; 68(4): 450-456.